The Centers for Medicare & Medicaid Services (CMS) released its new proposed coverage policy for hematopoietic cell transplantation (HCT) among Medicare patients. The proposal was a response to lobbying earlier this year from the National Marrow Donor Program and the American Society for Blood and Marrow Transplantation to include HSCT in the national coverage determination for sickle cell disease (SCD), myelofibrosis, and multiple myeloma (MM).
Prior to this action, most Medicare services do not have a national coverage determination for HCT that includes SCD and myelofibrosis, meaning patients with these conditions can be found financially liable for HCT if a local medical director deemed the procedure medically unnecessary. In addition, Medicare does not currently cover HCT among patients with MM, regardless of the local region.
This proposed change would add those three conditions to covered status under the process known as “coverage with evidence development.” This process is used by Medicare when the agency finds that the scientific evidence of a procedure’s efficacy is lacking in a particular population. Medicare agrees to pay for the service in exchange for the services’ providers gathering data, often using a registry.
CMS is currently seeking comments on the proposed decision.
Source: Centers for Medicaid & Medicare Services. “Proposed decision memo for stem cell transplantation (multiple myeloma, myelofibrosis, and sickle cell disease) (CAG-00444R),” October 29, 2015.